Child abuse rose during recession, research says (AP)

CHICAGO � An increase in child abuse, mostly in infants, is linked with the recent recession in new research that raises fresh concerns about the impact of the nation's economic woes.

The results are in a study of 422 abused children from mostly lower-income families, known to face greater risks for being abused, and the research involved just 74 counties in four states. But lead author Dr. Rachel Berger of Children's Hospital of Pittsburgh said the results confirm anecdotal reports from many pediatricians who've seen increasing numbers of shaken baby cases and other forms of brain-injuring abuse.

Berger decided to study this type of injury, known as abusive head trauma, after noticing an increase at her own hospital from late 2007 through June 2009. Her hospital averaged 30 cases per year during those recession years versus 17 yearly before 2007.

Though this abuse is still uncommon, the number of cases in the counties studied increased sharply, rising from about 9 cases per 100,000 children in pre-recession years, to almost 15 per 100,000 kids during the recession � a 65 percent increase.

By contrast, juvenile diabetes � a better-known condition � affects about 19 per 100,000 children younger than age 10.

Children studied were younger than 5, and most were infants. Most suffered brain damage and 69 died, though the death rate didn't rise during the recession.

Unemployment rates in the 74 counties rose during the five-year study. The proportion of children on Medicaid in those counties also increased, from 77 percent before the recession to 83 percent. However, insurance and family employment information were not reported for the abused children in the study.

Combine the stress of raising a young child with wage cuts or lost jobs and you get "a sort of toxic brew in terms of thinking about possible physical violence," said Mark Rank, a social welfare professor at Washington University in St. Louis. He said the study echoes sociological research linking violence with declines in economic well-being.

Along with U.S. Census data released last week indicating that a record 46 million Americans are poor, the study shows that "as poverty goes up and economic stagnation continues...there are really human costs involved," Rank said.

The study was released online Monday in Pediatrics.

The counties studied included Pittsburgh and western Pennsylvania; central and southern Ohio; and a handful of counties in northern Kentucky and in the Seattle area. The researchers examined medical records and national labor statistics for 2004 through November 2007 and compared them with data from the recession.

Of the 422 children diagnosed with abusive head trauma during the study, roughly 65 cases occurred each year before the recession, versus about 108 yearly during the recession.

Federal government data suggest that the recession did not affect child abuse rates. But the study authors said those numbers are based on reports from child protective services, not medical diagnoses, and did not address brain injuries specifically.

The research doesn't prove that the recession caused the abuse. Studying different regions and children from more middle-class families would help clarify if the recession really played a role, said Dr. Peter Sherman, director of the residency program in social pediatrics at Montefiore Medical Center in New York.

Sherman noted that most children studied were publicly insured even before the recession, suggesting that their families were already struggling financially.

Still, the recession affected many lower-income families, and Sherman said the study highlights "a very important issue."

Many of his patients are from poor families and abuse is not uncommon, he said.

He said pediatricians could help with prevention by asking families about difficulties paying for food or shelter and referring those in need to social service agencies. Sometimes just asking parents about stresses in their lives and acknowledging their struggles can help, he said.

Most parents who abuse young children aren't "ill-intentioned," he said. "Most of it is kind of just snapping...maybe being sleep-deprived and just losing it. It's something that can happen to anyone. Economics is just another stress" that can increase the risks, Sherman said.

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Online:

Pediatrics: http://www.pediatrics.org

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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UK surgeons separate twin girls joined at head (AP)

LONDON � Sudanese twins born with the tops of their heads joined together have been separated in a rare and risky series of operations at a London children's hospital, officials said Sunday.

Facing the World, a charity which helps disfigured children, said it had helped fund the four-stage operation on 11-month-olds Rital and Ritag Gaboura. Twins born joined at the head are known as craniopagus twins and they occur in about one in 2.5 million births.

Separating them can be dangerous, especially if � as in this case � there's significant blood flow between their brains.

"Incidences of surviving twins with this condition is extremely rare," lead surgeon David Dunaway said in a statement released by the charity. "The task presented innumerable challenges and we were all very aware of our responsibilities to the family and these two little girls."

The charity released before and after photographs of the girls. The before photo showed the two sprawled out on a bed, with their heads joined just above the hairline to form what appeared to be a single, solid unit. Facing the World said that separation took place in stages at London's Great Ormond Street Hospital, with two operations in May, the insertion of tissue expanders in July and the final separation on Aug. 15.

"Within days the twins were back on the general ward interacting and playing as before," the charity said. Its executive coordinator, Sarah Driver-Jowitt, predicted that the girls' parents � who haven't been named � may soon return home "with two healthy, separate girls."

Although rare, operations to separate twins linked by their heads aren't unheard of. In 2004, a team of doctors at New York's Montefiore Children's Hospital separated Filipino twins in four major surgeries that took place over 10 months. In 2003, surgeons in Dallas successfully separated 2-year-old Egyptian twins joined at the head.

One of the first successful operations to separate craniopagus twins took place in 1956, according to the U.S. National Library of Medicine.

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Online:

http://www.facingtheworld.net

http://www.gosh.nhs.uk/

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UK says metal hip replacements more troublesome (AP)

LONDON � People who get metal hip replacements are more likely to need a replacement compared to those who get a traditional plastic one, according to a new report from a large British registry.

The report Thursday from the National Joint Registry of England and Wales could lead to more caution among doctors when performing hip replacements. Earlier studies already led to a drop in the use of metal joints.

The report says almost 14 percent of patients who got an all-metal replacement needed the joint removed or replaced after seven years. That compares with just 3 percent of patients who got a joint made of plastic and needed a replacement within the same time.

Traditional hip replacements usually last more than 10 years, but British officials noted some of the metal hip replacements were failing within a few years. The average age of patients getting hip replacements was 67.

The U.K. registry includes records from about 1 million people who had hip, knee, and ankle replacements and is the world's largest joint database. There is no similar registry in the U.S.

Last year, a report by the British registry on the failure rate of one type of metal hip replacements made by a division of Johnson & Johnson led to its recall by the U.S. Food and Drug Administration. Among patients who received the Johnson & Johnson metal hip, almost 30 percent needed a new one.

Since the recall, use of all-metal hip replacements has fallen. In 2006, metal hip replacements were used in about 15 percent of procedures; that's now dropped to about 5 percent.

The report also found the obesity epidemic is having an impact. Experts said an increasing number of patients needing hip and knee replacements were overweight or obese.

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Dr. Oz accused of fear-mongering on apple juice (AP)

Arsenic in apple juice! Fed to babies! And it probably came from China! Television's Dr. Mehmet Oz is under fire from the FDA and others for sounding what they say is a false alarm about the dangers of apple juice.

Oz, one of TV's most popular medical experts, said on his Fox show Wednesday that testing by a New Jersey lab had found what he suggested were troubling levels of arsenic in many brands of juice.

The Food and Drug Administration said its own tests show no such thing, even on one of the same juice batches Oz cited.

"There is no evidence of any public health risk from drinking these juices. And FDA has been testing them for years," the agency said in a statement.

The flap escalated Thursday, when Oz's former medical school classmate Dr. Richard Besser lambasted him on ABC's "Good Morning America" show for what Besser called an "extremely irresponsible" report that was akin to "yelling `Fire!' in a movie theater."

Besser was acting head of the Centers for Disease Control and Prevention before joining ABC news as health and medical editor several years ago.

Arsenic is naturally present in water, air, food and soil in two forms � organic and inorganic. According to the FDA, organic arsenic passes through the body quickly and is essentially harmless. Inorganic arsenic � the type found in pesticides � can be toxic and may pose a cancer risk if consumed at high levels or over a long period.

"The Dr. Oz Show" did not break down the type when it tested several dozen juice samples for total arsenic. As a result, the FDA said the results are misleading.

Furthermore, the agency's own tests found far lower total arsenic levels from one of the same juice batches the Oz show tested � 2 to 6 parts per billion of arsenic versus the 36 that Oz's show had claimed.

Tests of the same batch conducted by two different food testing labs for the juice's maker, Nestle USA, which sells Juicy Juice under the Gerber brand, also found levels consistent with the FDA results.

In a letter published on the Oz show's website, Nestle said it told the program's producer in advance that the method the show's lab used was intended for testing waste water, not fruit juice, and "therefore their results would be unreliable at best."

The FDA also sent a letter in advance to the show and threatened to post its findings and the letters online if the program proceeded.

Oz went ahead.

"American apple juice is made from apple concentrate, 60 percent of which is imported from China," the website version of his report says. "Other countries may use pesticides that contain arsenic, a heavy metal known to cause cancer."

The show tested three dozen samples from five brands, and Oz claimed that 10 had more arsenic than the limit allowed in drinking water � 10 parts per billion.

However, the FDA said the arsenic in water tends to be inorganic, justifying the strict limit. In contrast, organic arsenic is the form usually found in food and juices. Tests over the last 20 years show apple juice typically has fewer than 10 parts per billion total arsenic.

The mercurial Oz is a heart surgeon at Columbia University and heads an alternative medicine program at New York Presbyterian Hospital. He was a regular on Oprah Winfrey's show for many years before getting his own program two years ago.

This is the first week of a new TV season, the first in two decades without Winfrey dominating the talk show scene.

Tim Sullivan, a spokesman for Oz's show, said in an interview: "We don't think the show is irresponsible. We think the public has a right to know what's in their foods."

Sullivan said Oz does not agree that organic arsenic is as safe as authorities believe. The show will do further tests to distinguish organic from inorganic arsenic in juice samples, he said.

"The position of the show is that the total arsenic needs to be lower," he said. "We did the tests. We stand by the results and we think the standards should be different."

In an interview with The Associated Press on Thursday, even Oz said he wouldn't hesitate to keep giving his four children apple juice.

"There's no question in my mind folks can continue drinking apple juice. ... There have been no cases at all of kids being harmed by elevated levels of arsenic, and the kinds of numbers we are talking about are not high enough to cause acute injury," he said.

He said he was concerned instead about the possible ill effects from drinking apple juice for many years.

An independent lab agreed with the FDA's contention that the form of arsenic matters.

Oz's testing "certainly begs the question how much of that is inorganic," the type of arsenic that is of prime concern, said Dr. Tod Cooperman, president of ConsumerLab.com. The company tests dietary supplements and publishes ratings for subscribers, much as Consumer Reports does with household goods.

However, Cooperman and others have long called on the FDA to strengthen regulation of contaminants.

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AP television writer David Bauder contributed to this report.

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Online:

FDA: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

and http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271746.htm

"The Dr. Oz Show": http://www.doctoroz.com/videos/arsenic-apple-juice

Besser-Oz faceoff: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

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FDA disputes TV doc's warning of apple juice risk (AP)

The federal Food and Drug Administration and a leading doctor are disputing suggestions by television show host Dr. Mehmet Oz that trace amounts of arsenic in many apple juice products pose a health concern.

Oz said on his show Wednesday that testing by a New Jersey lab has found what he implied are troubling levels of arsenic in many juices.

However, the FDA says the lab methods were not appropriate and that its own tests show much lower arsenic levels. The agency warned "The Dr. Oz. Show" producers in advance that their testing was misleading.

Dr. Richard Besser, a pediatrician and former acting head of the Centers for Disease Control and Prevention, also scolded Oz Thursday on ABC's "Good Morning America" show for scaring consumers with what Besser called an "extremely irresponsible" report, like "yelling `Fire!' in a movie theater."

The issue: arsenic is naturally present in water, air, food, and soil in organic and inorganic forms, according to the FDA.

"Organic arsenic is essentially harmless," the agency says, and it passes through the body quickly. Inorganic arsenic is the type found in pesticides, and consuming it at high levels or over a long period can cause concern.

The testing "The Dr. Oz Show" did was for total arsenic, and the FDA even disputes those levels. The agency's own tests found lower total arsenic from one of the same juice batches the show's lab tested.

"There is no evidence of any public health risk from drinking these juices. And FDA has been testing them for years," the statement says.

Note to consumers: They are talking about organic and inorganic arsenic � not organic versus non-organic fruits and vegetables.

An independent lab agreed with the FDA's contention that the form of arsenic matters.

"A lot of things can have organically bound arsenic like kelp, but most of those flow right through you" and don't accumulate, said William Obermeyer, a former FDA chemist who cofounded ConsumerLab.com. It is a company that tests dietary supplements and publishes ratings for subscribers, much as Consumer Reports does with household goods.

Tim Sullivan, a spokesman for Oz's show, sent an email saying: "We don't think the show is irresponsible. We think the public has a right to know what's in their foods."

Sullivan said Oz does not agree that organic arsenic is as safe as authorities believe, and that the show will do further tests to distinguish organic from inorganic arsenic in juice samples.

"The position of the show is that the total arsenic needs to be lower," he said. "We did the tests. We stand by the results and we think the standards should be different."

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AP television writer David Bauder contributed to this report.

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Online:

FDA: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

and http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271746.htm

"The Dr. Oz Show": http://www.doctoroz.com/videos/arsenic-apple-juice

Besser-Oz faceoff: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

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US lung cancer rates fall, led by Western states (AP)

ATLANTA � The West is leading a national decline in the rate of new lung cancer cases, with states like California and Nevada accounting for much of the improvement, particularly among women.

Smoking rates in the West have long been lower, and that's credited for the good health news for that region. Roughly 90 percent of lung cancer cases are attributed to smoking.

Lung cancer rates for men have been declining for years, but the drop among women is much more recent. The Centers for Disease Control and Prevention reported Thursday that lung cancer rates for women nationally decreased about 2 percent from 2006 to 2008, the last year studied. But the rate for women in select Western states fell about 4 percent in the same period.

Declines among men were similar, including a 4 percent decline in the West and about a 3 percent drop nationally.

"Over the past 20 years, lung cancer overtook breast cancer and became the No. 1 cancer killer of women. This is a horrific development that we have begun to turn around," said Dr. Tim McAfee, director of the CDC's Office on Smoking and Health.

Female lung cancer rates did not decline in every state, but six states saw significant drops � California, Nevada, Oregon, Washington, Texas and Florida. That was enough to pull down the national rate, even though female cancer incidence rose slightly in 14 states.

The rate of new lung cancer cases among males dropped in 35 states.

Lung cancer was something of a medical rarity 100 years ago, but is now one of the most commonly diagnosed cancers in the United States and is the form of cancer that kills the most people. More than 150,000 Americans will die of it this year, the American Cancer Society estimates.

It can take many years for lung cancer to develop in a smoker, although lung cancer rates can be seen to drop as soon as five years after smoking rates decline.

In the new report, CDC researchers looked at national cancer registries for the years 1999 through 2008, and also studied state-specific smoking rates from a separate data base that covered the same time period. The results are being published this week in a CDC publication, Morbidity and Mortality Weekly Report.

The CDC report didn't capture all 50 states. Six were left out because the authors were not able to say what was going on with lung cancer rates in those states for the earlier years of the analysis. Five of those states are in the South, where smoking rates and cancer rates tend to be high.

A stark regional difference was seen in 13 Western states. Texas, grouped in with the South by the researchers, also saw significant declines. The regional declines in male lung cancer incidence were similar for men.

Smoking rates are lower in the West. The national smoking rate has hovered around 20 percent for several years, but the rates have been below � in some cases, well below � 19 percent in California, Hawaii, Oregon, Washington, Idaho, Montana, Utah and Arizona.

Health officials and some advocates say at least some of the difference is due to some states having higher taxes on cigarettes, more comprehensive smoking bans and well-funded prevention programs. California is considered the prime success story for such health policies.

"Many Americans have a greater risk of lung cancer because of where they live and because their elected leaders have failed to implement proven measures to reduce tobacco use," said Matthew Myers, president of the Washington, D.C.-based Campaign for Tobacco-Free Kids.

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Online:

CDC report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6036a3.htm?s_cid

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